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Objectives: Depression has been reported to be a risk factor of cardiovascular disease in the western world, but the association has not yet been studied among Asian populations. The aim of this study was to investigate whether depression increases the risk of developing atherosclerotic cardiovascular disease (ASCVD) in a large Korean cohort study., Design: Population based cohort study., Setting: Database of National Health Insurance System, Republic of Korea., Participants: 481 355 Koreans (260 695 men and 220 660 women) aged 40-80 years who had a biennial health check-up between 2002 and 2005., Main Outcome Measure: The main outcome in this study was the first ASCVD event (hospital admission or death)., Results: Depression increased the risk of developing ASCVD by 41% for men and 48% for women. In men, 3-4 outpatient visits for depression increased the risk of angina pectoris by 2.12 times (95% CI 1.55 to 2.90) and acute myocardial infarction by 2.29 times (95% CI 1.33 to 3.95). Depression was also associated with stroke in men (HR 1.29, 95% CI 1.19 to 1.39) and in women (HR 1.37, 95% CI 1.29 to 1.46). However, no increased risk of ASCVD was found for men who received 10 or more depressive treatments, compared with those without any outpatient visit for depression., Conclusions: In this cohort, depressed people were at increased risk of ASCVD incidence. Therefore, individuals with depression may need routine monitoring of heart health that may prevent their future CVD risk., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)